Guide to Pregnancy and its related disorders and complications. Tips for caring of your baby properly while in pregnancy and after pregnancy.

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Most important in choosing a physician, midwife, or group practice for your maternity care is that you be comfortable with the thought of working with this person or group. You must have confidence in the individual or individuals, and this in itself is a good reason for looking into their qualifications and attitudes before making a commitment to them for example, you have strong feelings that you wish to breast-feed, it is not good for you to get your care from someone who is cool to the idea.The same goes for the conduct of labor. If you have attitudes about or experience with fetal monitoring, you should find out whether it is practice where you intend to deliver to require it or to individualize its use. If you have had a previous birth by cesarean and wish a vaginal birth, you should find out the attitudes toward such care on the part of those you choose to assist you in labor. What do you want your main source of pain relief to be? If you want to use relaxation, breathing, support. massage, and other nonpharmacologic remedies as much as possible, make sure your physician or midwife is comfortable with these options and won’t pressure you into medications or epidural anesthesia. If you want an episiotomy only on indication and not routinely, make sure that your obstetrician or midwife doesn’t believe in routine episitomy. If you want rooming-in with your baby 24 hours a day, but the hospital where your physician or midwife delivers does not provide for that you might think about switching providers. If you want an intravenous (IV) feeding tube only if you are dehydrated or need it for labor augmentation or medication, but the hospital at which your physician or midwife attends births insists on routine IVs, then you might want to find a provider at another facility, or consider a birthing center-or compromimise and have an IV

The fact that you have gone to a provider or facility does not mean that you are contracted to stay with it, if it turns out in the course of prenatal care that you are not at ease. If necessary, discuss this candidly with the people who have been providing your care so some resolution of the problem can be worked out amicably. Most of us who provide maternity care consider prenatal care as a commitment to follow through. We are often aware of the women who are uncomfortable in our care and are quite accepting when such women transfer themselves elsewhere. Of course, care will not be refused when you don’t exactly see eye-to-eye with your practitioners. Try to continue to raise your concerns and come to compromise solutions if you have no choice, as when you live in a small town and there are no alternative providers.

If you have trouble raising your concerns, something is a miss. You should never feel silly asking any question, you should not feel rushed, you should never feel that your concerns are made to seem trivial. It’s an old cliche, but the only silly question is the one you didn’t ask.

If you discover at the end of pregnancy that you are unhappy with what your practitioner is offering for labor and birth, you can certainly switch providers even at that late date, although some practitioners and birthing centers will not accept a woman late in pregnancy.

Most women at some point in their pregnancy, notice swelling in their feet and lower legs. Most times, the swelling is confined to the lower extremities. Swelling in your lower legs is made worse when you stand for long periods of time. If leg swelling is starting to become a problem, try to take several breaks during the day where you lie down with your feet raised. If you are working, try to move around frequently during the day. The action of your leg muscles helps return some of the excess fluid to other parts of your body. If you notice that one leg is much more swollen than the other, notify your care provider, since this can be a sign of a blood clot in your leg. However, remember that it is normal for the right leg to be slightly more swollen than the left, since the uterus tilts in such a way as to compress the drainage of blood from your right leg more than your left.

What do avoid

Diuretics are not safe in pregnancy.

Leg Cramps

Some women find that they wake up at night with sudden leg cramps. It’s not clear why these cramps become more common during pregnancy. Calcium supplementation may reduce symptoms and is safe during pregnancy. If leg cramps make you wake up at night, try to walk off the pain or place a warm compress on your calf. If you have persistent cramps try to pay special attention to your calves before going to bed. Stretch them out gently by stepping up on to a step and pressing your heels down one at a time. If you still have problems, talk to your doctor about magnesium supplements. Do not take magnesium supplements with out checking with your care provider first.

What’s safe to use

Calcium supplementation of 1 gm twice per day for 2 weeks.

Restless Legs Syndrome

About 10-20 percent of women will develop restless legs syndrome (RLS) during the second half of pregnancy. RLS usually occurs as you try to fall asleep. You might have tingling or other sensations in your lower legs, which give you the overwhelming urge to move your legs around. However, moving your legs or walking around does not relieve RLS. If your sleep is becoming disrupted, talk to your care provider. Sometimes this condition is associated with iron deficiency anemia, so iron supplementation may help. It’s best to avoid caffeinated drinks in the last half of the day because these may make symptoms worse.

Varicose Veins

The pressure of the growing uterus and consequent increased blood flow causes a notable increase in prominent veins in your upper and lower legs. As the pressure in your veins increases weakness in certain areas of the veins can cause the sides to balloon out. These are varicose veins. They may also occur in your vulva.

Varicose veins are more common with second and third pregnancies, but many women have them in their first pregnancy as well. Whether you get varicose veins or not is mostly genetic. You may be able to reduce the size of enlarged veins in your legs by wearing good support hose designed for pregnant women. However, many women find these hose hot and uncomfortable and of only slight benefit in reducing the appearance of varicose veins. Lying down with your feet up several times during the day may also help. If your veins remain enlarged after your pregnancy you can consider one of several cosmetic options, including laser treatments, sclerotherapy, and surgery. You should wait until after your have completed all your pregnancies to treat enlarged veins, since they are likely to return in subsequent pregnancies.

Stretch Marks

About half of all pregnant women will get stretch marks during pregnancy. Stretch marks often occur on the abdomen, but can also develop on your breasts and bottom. They are caused by microtears that occur in the connective tissue in your skin as the skin stretches more than it is able. Despite the claims made by manufacturers of various creams, no cream will prevent you from getting stretch marks. However, you can slightly reduce your chances of stretch marks by limiting your weight gain during pregnancy to 25-35 lb (11-16kg).

Stretch marks will fade over time, becoming faint and silvery. While you can’t prevent stretch marks, you can have them treated after pregnancy. Laser therapy is one option that is gaining in popularity. Plan on waiting to treat stretch marks until after all your pregnancies are completed since you are likely to develop more with each pregnancy. Treating stretch marks is considered cosmetic and is usually not covered by insurance.

Skin Changes

During pregnancy your skin undergoes enormous changes. Starting early on in pregnancy there is a big increase in the blood supply to your skin, which is euphemistically referred to as the glow of pregnancy.

Early in pregnancy, the most common skin change you may notice is an increase in acne as a result of hormone changes. It is safe to treat acne during pregnancy with creams and gels such as benzoyl peroxide or, after consultation with a dermatologist antibiotic creams. As you move in to the early second trimester, you may start to notice that your skin is darkening pregnancy stimulates production of the pigment melanin. You mal notice that pigmented areas of your body, including existing moles and your nipples, darken. New areas of pigment may also appear as your pregnancy progresses, including a dark line between your belly button and pubic hair called linea nigra. Some women also develop pigmentation across the nose and cheeks. Both these areas of pigmentation should fade after your pregnancy.

About two-thirds of women with lighter skin notice that the palms of their hands turn red. It results from the increased levels of the hormone estrogen in your body, and will disappear when you are no longer pregnant. Increased blood flow to your skin during pregnancy can also cause tiny red bumps surrounded by little red lines to form. These blemishes are called spider angioma and occur most often on the face, neck and upper chest but will fade after pregnancy. No treatment is needed unless he spider angioma are still present 3 months after pregnancy md you don’t like their appearance.

Sweating

Almost all pregnant women tend to feel warm during pregnancy. With this change in the way you perceive temperature and your increased metabolic rate, you are likely to notice that you are perspiring more. This is normal but can be irritating. Deodorant is safe during pregnancy so don’t worry if you find you need to use it more frequently.

Itching And Rashes

Many women have itchy skin during pregnancy, especially over their abdomen. Most of the itching seems to be associated with the physical skin stretching of pregnancy. Some women find that a cool sensation relieves some of the feeling of itching. Cool oatmeal baths or moisturizing lotion kept in the fridge may provide temporary relief. Itching may also be a sign of a condition called cholestasis of pregnancy, which sometimes develops in the third trimester. It is diagnosed with a blood test that examines the level of bile acids (produced by your liver) in your blood. If your doctor diagnoses this condition you will be given medication to reduce the excess bile acids. Thc usual treatment is a drug called ursodeoxycholic acid. High levels of bile acids can increase the chances of complications in your current pregnancy and may prompt your care provider to induce your labor prior to your due date. It is not know whether treatment with agents like ursodeoxycholic acid reduce the likelihood of pregnancy complications.

Warning Signs

If itching is accompanied by any of the following you should see your doctor.

• A significant bumpy rash on your abdomen this may be a condition called which is specific to pregnancy and needs more intensive treatment with prescription drugs.
• Persistent severe itching on your arms and legs with out a noticeable rash in the third trimester of pregnancy. This may be a symptom of a condition called cholestasis of pregnancy where bile acids from your liver build up in your skin, causing itching.

Safe Lifting

If at all possible, avoid lifting anything heavy, including your older toddler. If you do have to lift something, use the following technique.

• Stand with your feet hip-distance apart.
• Bend from your hips and knees, keeping your back straight.
• Keeping the object close to your body, use the strong muscles of your legs to lift.
• Keep your back straight for the whole lift.

Eggs

The eggs (ova) of all the higher mammals are similar in both size and appearance round with a clear, thin, shell-like capsule as rigid as stiff jelly. The capsule encloses liquid in which hundreds of fat droplets, proteins, and other materials (including the nucleus) are suspended. The egg, the largest cell of the whole body, is approximately V200 of an inch in diameter-about one-fourth the size of the period punctuating the end of this sentence. The eggs of mice, rabbits, gorillas, dogs, pigs, whales, and humans are all about the same size.

Spermatozoa

The spermatozoa of different species can show greater differences in form than the eggs. The human spermatozoon consists of an oval head mostly occupied by the nucleus. With the aid of the additional magnification provided by the electron microscope, it has become evident that the head is covered by a saclike structure. This structure is called the acrosome and provides an outer membrane, the acrosomal membrane. The acrosome is attached by a short neck to a cylindrical middle piece that terminates in a thin tail about ten times as long as the head. The tail, which consists of several hairlike fibers resembling a horse’s tail, is capable of rapid side-to-side lashing movements. These movements propel the spermatozoon.

A spermatozoon can swim an inch in 4 to 16 minutes, depending on whether it is traversing watery uterine or tubal fluid, or relatively thicker cervical mucus. Easily blocked by the slightest obstruction because of its small size, its path is seldom a straight line, and it frequently takes more than the minimum time to progress an inch.

When ejaculated, spermatozoa are suspended in seminal plasma, a thick mucoid fluid produced by the male during sexual orgasm. Semen, which arises from the prostate, the seminal vesicles, and the other accessory reproductive glands, is a homogenous fluid immediately upon ejaculation. Within a few minutes it sets to a gel called coagulum. After about 15 to 20 minutes, this gel is fully re dissolved into a viscous fluid. In some cases this transformation is not complete, then the semen is very viscous and may have tapiocalike lumps.

A fresh drop of semen seen under a microscope suggests the rush of traffic in a crowded city street. Myriad spermatozoa dash here and there, now steering straight ahead, now halted by a speck of dust, now free again to scurry out of the microscopic field.

Early Days

Being at home, as the main caretaker of your new baby, can be scary and tiring, especially if you are a first time mom. Figuring out how to bottle or breastfeed, how to get your baby’s arms through a shirt sleeve, or how to give a first bath can be challenging, particularly when you feel exhausted. You may need to ask help with chores, so you can focus on your baby and get some rest.

The First Few Days At Home

Both you and your partner may feel uneasy caring for your baby at first. Your new born may seem fragile and you may worry about doing something wrong. In addition, neither one of you may sleep particularly well because new babies do not sleep through the night. With all these changes in your daily rhythm, you may also wonder how you will manage going back to work in just a few weeks.

Realistic Expectations

It is important to realize that you will probably not have your life under control even several weeks from now. Being a parent is a messy business. Babies are unpredictable and with their arrival in our lives, they introduce an ever present element of surprise. However, living with this unpredictability will become easier with practice. Remember, babies are not as fragile as you might expect. Your baby just underwent a complete change in environment from a dark, cramped place to this bright, open world. With you close by, he or she can handle some parenting bloopers. Rest assured, your baby will enthusiastically inform you when things don’t go exactly the way he or she wants.

Accept that you will not be able to prevent all problems. Most moms worry about protecting their babies from diaper rashes, colic and so on and older moms may feel this even more if they have had a long wait to get pregnant or had a challenging pregnancy and birth. Take comfort in knowing that all parents have felt inadequate at some point. You will quickly learn how to handle things effectively, so don’t feel guilty if you are not an instant baby expert.

Just Baby And You

In the early days, before you become attuned to your baby’s more subtle signals, a lot of your actions may be a reaction to his or her crying. Communication is simple for babies if they are uncomfortable in any way, they cry. Crying can mean hunger a wet diaper, or just plain fussiness. Try not to let your baby’s crying make you resentful. It won’t take long before you get better at deciphering why your baby is crying and fixing the problem quickly. Soon the majority of your baby’s time should be crying free, unless he or she develops colic. Remember that crying is not harmful for your baby. If you feel that you are becoming overwhelmed and angry, it’s best to leave your baby safely in the crib and take a break for 5 minutes or so, then come back when you have calmed down.

Hold Your Baby When He Or She Is Sleeping Or Happy

In an attempt to create at least some time to get chores done in between feedings and diaper changes, it may be tempting to tiptoe out of your baby’s room as soon as he or she is calm enough to let you go. However, it’s important for you to spend some positive time with your baby. Have your new born go to sleep on your chest, listen to music, and take time to savor being a mom.

Soothing A Crying Baby

If your baby cries for more than a few minutes, even after you have changed and fed him or her, pick your baby up. If your baby cries a lot, use a baby carrier to keep him or her with you. Most babies are soothed by being held close to your body (or your partner’s). If this doesn’t work, try taking your baby out for a walk or a drive in the car. Many babies are soothed by music or the sound of household appliances such as washing machines and vacuum cleaners. Don’t worry about over pampering your baby. Calm, secure babies deal better with separation from their moms than anxious, lonely ones.

Dealing With Visitors

Visitors can help you feel supported and loved during the first weeks after the birth of your baby. A good conversation over a relaxing cup of coffee can provide a wonderful escape from diapers and burpings. However, it might be necessary to create some visiting boundaries that secure unstructured, restful time for you, as you get used to caring for your new born while still recovering your self. During the first few days, you may only want to see your closest family and friends. After this, set some visiting hours when your baby usually sleeps, perhaps so you can enjoy the time with your visitors.

How To Beat The Baby Blues

During the first few days and weeks after the birth of their babies, many women experience some emotional liability and crying jags, dubbed the baby blues. Try the following strategies to help. If these strategies don’t help, talk to your care provider. You may be one of the 10-15 percent of women who suffer from postpartum depression, a more serious condition that may require medical treatment.

Invite a friend to visit

Talking to some one who understands and listens can make all the difference.

Create time with your partner

Take the opportunities when they arise (when your baby sleeps, for example) to be alone with your partner.

Get out of the house alone

Ask your partner to baby sit for an hour or two so you can get out and see your own friends or do something you enjoy.

Join a support group

Interacting with others who are in the same situation can make you better.

Pamper yourself

Take a relaxing shower and pamper yourself when you can.

Pregnancy is a healthy state. Yet, pregnant women are more prone to physical discomforts than nonpregnant women. Some of these are caused by pregnancy, others exaggerated by it.One of the most common discomforts in pregnancy is nausea, with or without vomiting. Nausea and vomiting are usually mild and self limited to 6 or 8 weeks. The symptoms can appear anytime from about 5 to 8 weeks of pregnancy. They usually subside after about 13 to 15 weeks of pregnancy. Nevertheless, they can be quite disconcerting and interfere with usual activities. As many as half of all pregnant women experience nausea and vomiting.

Nobody knows exactly what causes nausea and vomiting in pregnancy. Theories suggest that they are due to increased hormone levels, low blood sugar, slowed digestion, an enlarging uterus, and emotions. On the plus side, a few studies have found that nausea and vomiting are related to a good pregnancy outcome, although this, too, is only a theory.

Because nausea and vomiting in pregnancy often occur in the early hours of the day, the condition has been called morning sickness. In fact, nausea and vomiting are by no means limited to the morning. On occasion, the vomiting becomes severe or persists beyond the first trimester. This is called hyperemesis gravidarum. For woman whose nausea and vomiting are annoying rather than pathologic, a number of home remedies can be effective to varying degrees for varying women.